Panic Disorder

Panic disorder refers to sudden and repeated panic attacks—episodes of intense fear and discomfort that reach a peak within a few minutes—during which time the individual experiences physical symptoms such as chest pain, heart palpitations, breathlessness, vertigo, or abdominal distress, sometimes accompanied by the fear of losing control or dying, according to the DSM-5. The symptoms may seem similar to those of a heart attack or other life-threatening medical conditions. Panic disorder is often diagnosed after medical tests or emergency room visits have ruled out other serious illnesses.

Panic disorder affects about 2 to 3 percent of American adolescents and adults, and occurs twice as often in women than men. Panic attacks often emerge in young adulthood, but not everyone who experiences a single panic attack goes on to develop the disorder.

Symptoms

Panic disorder is diagnosed when a person experiences unexpected panic attacks, which include at least four of the symptoms below:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath or a sensation of smothering
  • A choking feeling
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feeling detached from oneself or reality
  • Fear of losing control or of impending doom
  • Fear of dying
  • Numbness or a tingling sensation
  • Chills or hot flashes

In addition, at least one panic attack occurs after a month of persistent fear of another panic attack or its consequences, such as feeling out of control, or changing one's behavior to avoid an attack. A panic attack also cannot be due to substance use, a medical condition, or a different mental health disorder.

    Causes

    The causes of panic disorder are not fully understood, but certain elements are linked to the disorder. Those who are especially sensitive to anxiety, neuroticism, and negative emotions may be at an increased risk. Childhood physical and sexual abuse is a risk factor, as is separation anxiety in childhood, although less consistently. A loss or stressor can precede a first panic attack, such as the death of a loved one or a harmful experience on drugs. Genetics are thought to play a role as well.

    Researchers have conducted both animal and human studies to pinpoint the particular parts of the brain that are involved in anxiety and fear. Because fear evolved to deal with danger, it sets off an immediate protective response without conscious thought. This fear response is believed to be coordinated by the amygdala, a structure deep inside the brain. Although relatively small, the amygdala is quite complex, and recent studies suggest that anxiety disorders may be associated with abnormal activity within it.

    Treatment

    Panic disorder is effectively treated with medications and therapy. Appropriate treatment by a professional can help lessen or prevent panic attacks by reducing the symptoms or the fears related to having an attack. Relapses may occur, but they can be treated effectively.

    Therapy

    Cognitive-behavioral therapy (CBT) teaches patients to see the links between their thoughts, beliefs, and actions. By changing distorted thought patterns that maintain anxiety and by exposing the person to anxiety-provoking symptoms or situations in a gradual manner, CBT can help create mastery over anxiety and panic symptoms. Therapy may help those with panic disorder to:

    • Understand their distorted views of life stressors, such as other people's behavior or life events.
    • Learn to decrease their sense of helplessness by recognizing and replacing panic-causing thoughts.
    • Learn stress management and relaxation techniques to help when symptoms occur.
    • Practice systematic desensitization and exposure therapy, in which they are asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation also has been used with success to help people overcome their fears.

    Medications

    Several medications have been found to be effective for relieving panic disorder. Antidepressants are one class of medications that must be taken for several weeks before symptoms begin to disappear. 

    Selective serotonin reuptake inhibitors, or SSRIs, work in the brain via a chemical messenger called serotonin. SSRIs commonly prescribed for panic disorder include Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa). SSRIs are also used to treat panic disorder when it occurs in combination with obsessive-compulsive disorder, social phobia, or depression. Patients may initially experience nausea, drowsiness, diarrhea, or sexual side effects when they first take SSRIs, but over time, symptoms subside. An adjustment in dosage or a switch to another SSRI may also correct the problem. Clients should discuss all side effects or concerns with their doctor so that any needed changes in medication can be made.

    Benzodiazepines, including alprazolam (Xanax) and lorazepam (Ativan), may be prescribed for patients to help with more acute symptoms of panic disorder. These drugs alleviate symptoms quickly and have fewer side effects other than drowsiness, but frequent use may lead to dependence on the medication. They are not recommended for patients who have alcohol or substance abuse issues.

    When taking medications, it is important for patients to be educated about potential side effects, the rationale for the type of medication prescribed, and other drugs or substances that may counteract or interact with the effects of the medications. Before stopping to take the prescribed drug, or if the medication does not seem to alleviate symptoms, the doctor should be consulted.

    References

    • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
    • National Institutes of Health, National Library of Medicine
    • National Institute of Mental Health
    • Lee N. Robins, Darrel A. Regier, eds., Psychiatric Disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991
    • US Department of Health and Human Services
    • Archives of General Psychiatry

    Last reviewed 02/07/2019